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SYMPTOMS l The classic symptom is intermittent, painless metrorragia or spotting only postcoitally or after douching. l Probably the first symptom of early cancer of the cervix is a thin, watery, blood-tinged vaginal discharge that frequently goes unrecognized by the patients. l As the maligancy enlarges, the bleeding episodes become heavier and more frequent, and they last longer.

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SYMPTOMS l Late symptom or indicators of more advanced disease include the development of pain referred to the flank or leg. l Many patients c/o dysuria, hematuria or rectal bleeding or obstipation resulting from bladder or rectal invasion. l Distant metastasis and persistent edema of one or both lower extremities as a result of lymphatic and venous blockage by extensive pelvic wall disease are late manifestation of primary disease and frequent manifestations of recurrent disease.

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Gross appearence l Three categories of gross lesions have traditionally been described. l The most common is the exophytic lesion, which usually arises on the ectocervix and ofter grows to form a large, friable,polypoid mass, arises on the endocervical canal, creating barrel-shaped lesion. l Little visible ulceration or exophytic mass like a stone-hard cervix that regresses slowly with radiation therapy. l Ulcerative tumor,usually erodes a portion of the cervix or replacing the cervix, erodes a portion of the upper vaginal vault with a large crate.

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Pap smear l Pap smear is the most common and effective screening method. l Exfoliated cervical cells are scraped from the cervix by spatula. The entire T zone must be sampled. Incomplete sampling could produce a false-negative smear. l The endocervical canal is also sampled with a swab or cytobrush. l Cells are fixed immediately to avoid air-drying cytologic artifacts

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Pap Smear Show Squamous Cell Carcinoma

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Colposcopy and directed biopsy l A pap smear is only a screening test. A definitive diagnosis requires inspection of a well-visualized cervix with a colposcope. l The cervix is painted with 3% acetic acid solution to enhance surface alterations and vascular changes. l The colposcope evaluation is considered adequate or satisfactory if the complete T zone and full extent of the lesions is visualized. l Areas of abnormality(e.g., White epithelium, mosaicism, and punctation) are selectively punch biopsied.

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Routes of spread l Into the vaginal mucosa, extending microscopically down beyond visible or palpable disease; l Into the myometrium of the low uterine segment and corpus, particularlly with lesions arising from the endocervix. l Into the paracervical lymphatics and from there to the most common involved lymph nodes ( the obturator; hypogastric, and external iliac nodes). l Direct extending into adjacent structures or parametria, reaching to the obturator fascia and the wall of the true pelvis

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How can we evaluate the patient? l Stage: Pelvic examination, Rectovaginal examination, Intravenous pyelography(IVP) Ultrasonography or CT l Staging is clinical, but can use IVP and CT l Cervical cancer is the only gynecologic malignancy that is not surgically staged

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Clinical Staging for Cervical Carcinoma l Stage II Invasion is beyond the cervix but not to the pelvic wall or lower third of the vagina IIAParametria is not involved IIBParametria is involved

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Clinical Staging for Cervical Carcinoma l Stage III Invasion is to the pelvic wall or lower third of vagina IIIAPelvic wall is not involved IIIBPelvic wall is involved; hydronephrosis or nonfunctioning of the kidney may occur because of tumor

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Clinical Staging for Cervical Carcinoma l Stage IV Invasion is beyond to the true pelvis or to the mucosa of the bladder or rectum. IVASpread is to adjacent organs IVBSpread is to distant organs

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How can we explain to the patient? l What is cervical cancer? l How many treatment modes for cervical cancer ? l Why we choose surgery or RT for the patient? l What is the side-effect of the treatment? l What is the prognosis and survival rate?

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Cervical cancer l Cervical cancer is the most common gynecologic malignancy. l The most common tumor type is squamous cell carcinoma (80%) l A pap smear is only a screening test! l Definitive diagnosis of cervical cancer requires a tumor BIOPSY! l Radiation and operation are both effective treament. l Goal of the treatment: cure, except stage IV